Editorial on 'redistribution' offers refreshing view, and other letters

Thank you for the commentary "Spare us the complaints about healthcare 'redistribution'". It is a refreshing departure from the usual commentary on this subject we read these days.

As I tell my students, and you observe correctly, virtually all public policy is redistributive, and not invariably from high-income to low-income families. Huge “rents,” as we economists call them, routinely flow from the tax-paying middle class to the upper end of the income distribution. The military industrial complex and the healthcare industrial complex are conduits for such rents.

It is also good that you expose so-called tax expenditures for what they are: a form of tax-financed public spending, given any existing tax system in place. When A gets a tax preference and we seek to balance the public budget, taxpayers B, C, D, etc., necessarily must pay extra taxes to make up for the revenue loss from the tax preference. It is why economists view tax preferences as just another form of public expenditure. Grover Norquist will never get it, nor anyone else who believes that eliminating tax preferences is a form of tax increase.

Uwe E. Reinhardt

Regarding the article "Providers not required to keep EHR audit systems turned on", the lack of audit trails violates patients' rights to an accounting of all disclosures from electronic health records and the purpose of the use.

Congress added that patient protection to the HITECH Act in 2009, but the industry is still fighting to prevent the regulations from being written. Congress decided that consumer protection was critical to provide accountability and transparency of access, use, sale or disclosures of patient health information from EHRs.

How crazy is it for others to control our most sensitive personal data and have no way to know who used it, why or who they sold it to? How crazy is it to ask us to participate in opaque systems that use and disclose our most sensitive personal data and tell us the benefits outweigh the risks?

Why should we use EHR systems that put us at huge risk of data theft, data sale, discrimination, ID theft and medical ID theft?

American patients should have systems that put us in control of our health information and require ironclad, comprehensive data privacy and security protections.

Dr. Deborah Peel

Regarding "Medicare to pay flat rate for clinic visits", beautiful! Now all we need is a gold-plated invitation to quit seeing Medicare patients. But it depends. If the single payment to physicians is $250 per office visit, then Medicare patients will have no problem finding docs. If the reimbursement is $50 or $75 per office visit, then goodbye Medicare patients.

It's like the pending decrease in outpatient physician payment is meant to push patients to the hospital-based docs since—interestingly enough—their payment is spared. That pushes patients into ACO-based practices, which supports Obamacare and the ACO push.

Call me crazy, but if the $1.5 trillion pushed into Obamacare was just used to fairly reimburse physicians, then Medicare and Medicaid would flourish and patients' access to any physicians would not be a issue. Way to mess up, U.S. government.

Dr. James Taylor